Yale University Study Finds Racial Bias in Emergency Room Procedures

A new paper by researchers at Yale University finds racial disparities in the use of physical restraints on children who are admitted to the hospital emergency department. Black children are more likely than White children to be subdued with restraints during visits to emergency rooms.

The researchers looked at data from 11 emergency departments across New England between 2013 and 2020. Their sample included over 551,000 visits of patients ages 0 to 16. According to their analysis, Black pediatric patients were 1.8 times more likely to receive a physical restraint than White patients. Boys were more likely than girls to be restrained. The results mirror those in another Yale-led study that looked at the use of restraints on adults in emergency departments. That study found that Black males who lacked insurance were more likely than patients of other racial demographics to be physically restrained.

According to standard ED protocol, the researchers said, hospital staff are supposed to use de-escalation techniques and only implement physical restraints as a last resort. But the researchers said that systemic bias and racism, including the “adultification” of Black youth, and particularly Black boys, could change the way these children are perceived by nurses, doctors, and other specialists.

When pediatric patients are restrained in the ED, they are typically tied to the bed. It is done “in concern for their safety or others’,” said Destiny G. Tolliver, a second-year postdoctoral fellow and scholar in the National Clinician Scholars Program at Yale, and co-author of the study. “It can be very traumatic and scary for a child, looking up at all these people who are stopping them from moving.”

Dr. Tolliver is a graduate of Yale University, where she majored in linguistics. She earned her medical degree at the Morehouse School of Medicine in Atlanta.

The full study, “Racial and Ethnic Disparities in Physical Restraint Use for Pediatric Patients in the Emergency Department,” was published on the website of the journal JAMA Pediatrics. It may be accessed here.

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